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					                                 FURTHER INFORMATION
If you would like to obtain more copies of this report, a copy of the full accounts or more detailed
                     information about any aspect of the PCT, please contact:

                 Helen Stubbs, Corporate Communications and Media Manager
                                   Bury Primary Care Trust                                                              Annual Report 2005-06
                                       21 Silver Street
                                          BL9 0EN

                                       Tel: 0161 762 3167

                                                                                                       Having a Patient Focus - Achieving Meaningful Outcomes
                                                                                                                     Valuing Staff - Team Working
                                                                                                       Having a Positive Approach - Being Open and Transparent
                        Continued commitment and dedication                                           About The PCT
                                                                                                      Bury PCT receives the NHS budget for the local population and is responsible for planning and
                                                                                                      delivering health services for the people of Bury.
We are pleased to introduce the Annual Report for Bury Primary Care Trust for the period April
2005 to March 2006.                                                                                   The PCT also ensures that local hospital services and specialist treatment are available for local
                                                                                                      patients who need them.
We would like to take this opportunity to thank those people who work within our local health
services, including the local Acute Hospital and Mental Health Trusts and our colleagues in           The PCT directly provides Community Services from a range of bases including health centres,
primary care, including local GPs, Pharmacists, Opticians and Dentists.                               the acute hospital site and other community premises.
Our thanks also go to our local partners, Bury Metropolitan Borough Council (MBC), Bury Social        ‘Bury PCT is committed to improving, expanding and modernising the delivery of services,
Services, Voluntary Agencies, local Users, Carers and Volunteers.                                     to maximise health and well-being and promote self care to increase the amount of control
                                                                                                      and choice for local people.’
The past year has been another challenging but successful period, which has seen the
establishment of the Provider Board within the Trust, the further development of the Local
Improvement Finance Trust (LIFT) projects and closer working partnerships to deliver a common         Local health services coordinated by the PCT are broadly provided in four ways:
goal of excellence in care across Bury.
                                                                                                      1.   Services (mainly community health services) provided locally by directly managed PCT staff.
Our thanks are extended to the Staff and to the Stakeholders of the PCT for continuing to achieve
the consistently high standards of care that we have come to expect within Bury.                      2.   Primary Care Services provided through national contracts with GPs, pharmacists, opticians
                                                                                                           and dentists.
We are certain that the next 12 months will bring new challenges and are confident that with the
excellent commitment of the staff of Bury PCT, we will rise to these challenges and further improve   3.   Hospital services commissioned by the PCT on behalf of the population of Bury: i.e. locally at
the healthcare services available to the population which we serve.                                        Fairfield General Hospital Bury and at over 20 other hospitals.

Personal Message from Mrs Hilda Harvey                                                                4.   A range of specific services provided by voluntary or non-statutory agencies with NHS
                                                                                                           funding, such as Bury Hospice.
The reporting period to which this report relates concluded with the retirement of Evan Boucher,
the PCT Chief Executive since its creation in 2002. On behalf of us all at the PCT may I once more
take this opportunity to thank Evan for his unswerving drive and commitment to improving              The PCT employs around 775 staff. The population for Bury PCT is 182,000 and the PCT had an
healthcare within Bury.                                                                               annual spend of £215m in 2005-06

                                                                                                      Bury PCT directly provides a diverse range of services which include:
                                                                                                      District Nursing                                Health Visiting
                                                                                                      School Nursing                                  Evening and Night nursing
                                                                                                      Orthoptic services                              Community Dental services
                                                                                                      Speech and language services                    Walk-in centre services
                                                                                                      Dental access centre services                   Occupational therapy
                                                                                                      Podiatry Services                               Family planning services
                                                                                                      Dietetic services                               Phlebotomy services
                                                                                                      Young persons advisory services                 Health promotion
                                                                                                      Specialist nursing services                     Discharge liaison
                                                                                                      Child Protection                                Rapid response/intermediate care
                                                                                                      Supported Living for Learning Disabilities
Hilda Harvey                             Stephen Mills                         Dr. Derek Fletcher
Chair                                    Chief Executive                       PEC Chair

Having a Patient Focus – Achieving Meaningful Outcomes – Valuing Staff – Team Working
              – Having A Positive Approach – Being Open and Transparent                                                                    Having a Patient Focus
                                          1                                                                                                          2
Bury PCT continues to work to its six key values that were originally developed by staff, colleagues   The Development of Non-medical Prescribing
and stakeholders when the PCT was first established during 2002.
                                                                                                       Over the last few years more Community Nurses have been able to become prescribers
Bealey Community Hospital delivers high quality care to adults whose GP supports their stay at         completing the Independent or Supplementary training in areas of Practice Nursing and Specialist
Bealey. Over the past four years, the values have been successfully embedded throughout the            Nursing. Secondary Care has also trained Nursing and Allied Health Professionals to become
organisation and are evident in all streams of work. The PCT continues to ensure that the values       prescribers. In 2006 the full Formulary has been opened up to Independent Prescribers who meet
are reviewed on a regular basis to ensure they are still relevant to the work of the PCT.              set criteria. Non-Medical Prescribing is part of the government’s commitment to modernising the
                                                                                                       NHS, aiming to make access to medicines easier for patients to access by enabling highly trained
The 6 Key Values for Bury PCT are:
                                                                                                       professionals to bring caring for patients closer to home by increased flexible use of workforce
o     Having a patient focus                                                                           skills.
o     Achieving meaningful outcomes                                                                    Bury PCT now has 104 non-medical prescribers of which 79 are trained to work from the limited
o     Valuing staff                                                                                    formulary, 7 are Supplementary prescribers and 18 are Independent prescribers.
o     Team working
o     Having a positive approach, and                                                                  There are currently 10 staff in training and five staff have applied to start training September 2006.
o     Being open and transparent
                                                                                                       Developing Essence of Care
Partnership Working                                                                                    The initiative covers ten benchmarks to encourage best practice across the professions covering
                                                                                                       nursing and allied health professionals. The ten areas are;
The PCT works closely with its local partners, Bury Metropolitan Borough Council, Social
Services, Voluntary Agencies, Local Service Users, Carers and Volunteers.                              •   Continence and bladder and bowel care
                                                                                                       •   Personal and oral hygiene
                                                                                                       •   Food and Nutrition
KEY ACHIEVEMENTS AND IMPROVEMENTS DURING 2005/06                                                       •   Pressure Ulcers
Bealey Community Hospital extension and refurbishment                                                  •   Privacy and dignity
                                                                                                       •   Record Keeping
Bealey Community Hospital delivers care to adults over the age of 18,
who have a GP in Bury that has signed an agreement with the PCT to                                     •   Safety of Clients and mental health needs in acute mental health and general hospital settings
manage patients at Bealey.                                                                             •   Principles of self-care
                                                                                                       •   Communication
The hospital now has 20 beds, an increase from the original 16.
                                                                                                       •   Promoting Health
Building work commenced in February 2005 to modernise, extend and
improve facilities at the unit. A conservatory was added for patient                                   All are interrelated and each benchmark has a set of factors and indicators that set the standard
use; the dining room extended; a quiet room created; occupational                                      for the benchmark.
therapy assessment kitchen and a physiotherapy room were built to facilitate the rehabilitation        In line with the 2001 NHS Plan and following the launch of ‘Essence of Care’ in Bury, the PCT has
process. The hospital also has piped oxygen and suction, a lift for access to the first floor and a    an Essence of Care Group to steer the development of patient focused care that is multi-
completely renovated hospital. The Hospital League of Friends has supported the unit both              professional covering Nursing and Allied Health Professionals and working closely with Clinical
physically and financially. They have purchased many items of equipment including the new dining       Governance and PALS.
The use of Bealey Hospital is very broad, patients requiring rehabilitation are admitted, many on
the Intermediate Care Scheme, others need symptom management in chronic disease care;
palliative management for end of life care; and for the treatment of leg ulcers and pressure sores.
All patients are cared for by their own GP and many members of the multi-disciplinary team.

                               Achieving Meaningful Outcomes                                                                                      Valuing Staff
                                             3                                                                                                          4
Improving Dental Services                                                                            1. Choosing Health Diet Plans
During the year, more NHS dentists began working in Bury.                                            The Nutrition and Dietetic Department has planned a detailed programme to enable
The PCT has also identified additional capital improvement                                           comprehensive delivery of all Department of Health ‘Choosing Health Diet’ commitments. A bid
funding to strengthen dental services through premises                                               for funding has been submitted to Bury PCT Commissioning Services to enable delivery of all diet
refurbishments and practice improvements.                                                            projects. Projects within the whole programme include:
In April 2005, the PCT appointed a Dental Development                                                •      Obesity Strategy and Care Pathway
Manager to assist in the implementation of the new dental                                            •      Healthy Start Scheme
agenda. During the year, the PCT’s dental commissioning                                              •      5 A DAY in Bury
team undertook the work necessary for the implementation                                             •      School Fruit and Vegetable Scheme
of the new dental contract on 1st April 2006, and a Dental                                           •      School Meal Reforms
Bureau was established to help patients find an NHS Dentist.
                                                                                                     •      Healthy Schools
During the reporting period, the Dental Access Centre (DAC) continued to work in conjunction with    •      New NHS Dental Contractual Arrangements.
local practices to ensure that unregistered patients, and particularly those in pain, were able to
obtain a timely appointment with an NHS dentist. The Community Dental Service maintained its
                                                                                                     2. Health Trainers Food
specialist role, providing care for patients with special dental needs.
                                                                                                     For many community members the transition into a healthier way of life will be plagued by barriers
                                                                                                     to change. Thus, the Government has devised a personalised thread within the Choosing Health
Training of Assistant Practitioners and Advanced Practitioners                                       strategy. The creation of personal health guides or ‘Health Trainers’ to facilitate behaviour change
                                                                                                     in those who desire a healthier lifestyle. Bury is one of the few Primary Care Trusts who will recruit
                               Assistant Practitioners and Advanced Practitioners are part of the    Diet Health Trainers. Their role will be to assist individuals in making small changes that will
                               ‘Delivering the Workforce’ project and have been established for      improve their diet and promote optimum health. They will be trained to provide low level
                               four years.                                                           information on diet and nutrition and cover basic areas from the Balance of Good Health such as
                               To date the Greater Manchester SHA in partnership with PCTs,          5 a day and hydration.
                               Acute Trusts and training departments have 500 qualified
                               Assistant Practitioners and 500 in training. The aim of these         3. School Fruit and Vegetable Scheme
                               developments is to “increase and modernise the clinical workforce
                               through the development of patient centred roles’’.                   98% of schools are successfully participating and the benefits of the scheme have encouraged
                                                                                                     many schools to establish fruit and vegetable tuck shops.
The new roles meet the agendas of ‘Choosing Health’ and ‘Our Health, Our care, Our say’.
They link to partnership working as the roles are generic and able to cross boundaries to support    4. Healthy Schools
services in nursing, therapies and Social services.
                                                                                                                                95% of Bury schools are now working towards achieving the new
                                                                                                                                Healthy Schools Standard and healthy eating is now one of four
                                                                                                                                compulsory criteria. To support schools with this a Food in Schools
Encouraging Good Nutrition
                                                                                                                                Training Event took place in June 2006. A new Bury Healthy Schools
Poor nutrition within England has impacted upon morbidity and mortality rates for cancer,                                       Co-coordinator was appointed in January 2006 to support schools
cardiovascular disease, diabetes and obesity. The more disadvantaged and vulnerable in society                                  within the Healthy Schools process.
tend to have poorer diets. Tackling poor nutrition and the related public health consequences is a
high priority for Bury PCT and considerable work has been undertaken in the past year to improve
health in relation to diet. Some of the key areas include:                                                                      5. Healthy Eating for Children and Young People
                                                                                                                                A Children and Young People’s Healthy Eating Group was established
                                                                                                                                in 2005 to act as a working group to address poor dietary habits in the
                                                                                                                                young. One of the primary aims of the group is to support the timely
                                                                                                                                implementation of the new school meal standards and to improve the
                                                                                                                                whole school approach to nutrition in schools.

                                         Team Working                                                                                   Having A Positive Approach
                                              5                                                                                                     6
6. Golden Apple Award Scheme                                                                           The Vision for the Safeguarding and Protecting Children’s service is:
This is a reward scheme that was established in August 2005 to address healthy eating in private       ‘To develop integrated services which meet the needs of vulnerable children, helping them to
nurseries and is a joint scheme between the Department of Nutrition and Dietetic Department and        achieve the five ‘every child matters’ outcomes to the greatest possible extent. This will be
Environmental Health Department.                                                                       accomplished by: improved communication; multi-agency working; increasing workforce capacity;
                                                                                                       developing staff competencies and support systems; increased accountability; and above all by
Approximately, half of all private nurseries are participating within the scheme. The principal aims
                                                                                                       awarding our vulnerable children the recognition they deserve’.
of the scheme are to improve snacking habits and improve overall hygiene in nurseries, focusing
primarily on hand washing.                                                                             Some of the key achievements over the last 12months are;
                                                                                                       •   A Safeguarding and Protecting Children’s policy has been developed in line with government
7. Obesity                                                                                                 guidance.

Within Bury and throughout the country, there is a lack of local level data on the prevalence of       •   A training strategy has been developed.
obesity in children. Bury PCT is undertaking a surveillance project in all Bury Primary Schools to     •   Basic Awareness in Safeguarding Children training (full day sessions) have been developed,
establish a baseline of obesity prevalence in Year six and Reception children. The data collected          and a training programme determined for the year.
from this work will be used to prioritise funding and allocation of resources.                         •   A child protection supervision process has been developed
Within the last year great strides have been made in delivering the Obesity Strategy and related       •   A designated nurse for child protection has been appointed
projects e.g., ‘Weight Wise’ at work is a project developed by the Nutrition and Dietetic              •   Looked after children assessments have been mainstreamed successfully into the Health
Department and the Groundwork Trust. The project involves a Community Nutritionist attending               visiting and school nurse service.
various businesses based within Bury and providing practical advice and recommendations on
how to achieve sensible and sustained weight loss.                                                     A comprehensive action plan to further strengthen the safeguarding and protecting of children is
                                                                                                       in place to cover the next 12 months and beyond.
The Nutrition and Dietetic Department runs a rolling programme of
slimming groups, each group runs for a three month period and
has places for up thirty people. The Nutrition and Dietetic                                            Improving Primary Care Premises and Facilities
Department concurrently offers one to one appointments for
patients to facilitate and support weight loss.                                                        Bury PCT is in the process of designing and procuring a number of Primary Care Resource
                                                                                                       Centres and Health Centres in the Borough that will greatly enhance healthcare delivery and
The Obesity Steering Group has been re-established to enable co-                                       provide care closer to home for a significant number of patients who currently have to attend
ordination of all work related to the obesity strategy and to ensure                                   hospital for their conditions. Three new Primary Care Resource Centres are already in the design
synergy in approach to tacking obesity. The group focuses                                              stage, two of these will be located in Bury town centre (Gateway and Townside Fields) and the
primarily on delivering the obesity strategy and care pathway. Strong links have now been              other in Radcliffe. Service planning is already underway for developments at Tottington,
established between this group and the Manchester Strategic Health Authority (MSHA) Obesity            Ramsbottom, Whitefield and Prestwich. Further schemes are planned and this substantial
Steering Group.                                                                                        investment in health care in Bury, which is equivalent to more than £50 million capital expenditure,
                                                                                                       will make a real difference to health care for our patients.
8. Elderly population                                                                                  The first scheme will be the Radcliffe Primary Care Resource
Partnership working has been established between Age Concern and the Nutrition and Dietetic            Centre, which is being provided through the Bury, Tameside
Department. This project has involved a Community Nutritionist from the Nutrition and Dietetic         & Glossop LIFT (Local Improvement Finance Trust) and is
Department visiting various venues within Bury addressing issues such as food fortification,           expected to be operational by Summer 2008. The Bury town
weight gain, weight loss and healthy eating in later life.                                             centre scheme, where the Gateway and Townside Fields
                                                                                                       Primary Care Resource Centres are being planned in
                                                                                                       conjunction with the major redevelopment of the area, are the
Ensuring Children are Protected                                                                        only developments being provided outside of LIFT and they
Bury PCT is committed to safeguarding and protecting children. The duty to make arrangements           are expected to be completed in late 2008 / early 2009.
to safeguard and promote the welfare of children is part of the comprehensive programme of
‘Change for Children’ which began with the publication of the ‘Every Child Matters’ green paper in
September 2003. At the very heart of this programme is the recognition that protecting children
from harm cannot be separated from policies to improve children’s lives as a whole.

                                 Being Open and Transparent                                                                                 Having a Patient Focus
                                             7                                                                                                        8
The development of new healthcare facilities is one of the key steps in delivering the Caring for       Stop Smoking Services
Bury Plan which will enable the provision of care closer to home, delivery of improved services for
                                                                                                        The PCT is committed to working towards a smokefree Bury for all and in making that commitment
patients, and better clinical support to GP’s and their staff. The purpose-built Primary Care
                                                                                                        wants to support anybody wishing to quit. Over the last three years the numbers of four-week
Resource Centres (PCRCs) will enable patients both to see their GP and have treatments from
                                                                                                        quitters has continued to grow and at the end of 2005/06 a total of 2,612 four-week quitters was
nurses and allied health professionals for services such as podiatry, audiology, physiotherapy, and
                                                                                                        recorded for Bury Stop Smoking Service.
occupational therapy. The Town Centre schemes will also provide a new base for the Bury Walk
In Centre, the Bury & Rochdale doctors on call out of hours service, and Dental Access Centre.          The PCT is also committed to providing a smoke free environment for all staff, patients and visitors
                                                                                                        of Bury PCT, and has developed the ‘No Smoking At Work’ policy to ensure that this goal is
                                                                                                        achieved. The policy was launched by the Mayor of Bury on the 1st June 2006. The policy applies
Extending Services Close to Home                                                                        to employees, Non- Executive Directors, members of the public, contractors and others working
In addition, the new PCRCs will provide an extended range of services, including: - Minor surgery,      in, visiting or using premises or vehicles owned or leased by the PCT. It also applies to tenants of
Outpatient consultations, Diagnostics. The intention of the PCT is to work with GPs and local           PCT premises, everyone entering or using PCT buildings and grounds, including patients and
hospitals to ensure that patients in Bury have access to new purpose-built facilities which will        visitors.
avoid hospital attendance for those patients whose services can be provided more locally. By            The PCT is also developing guidelines to support PCT staff delivering their services in the
2008 it is expected that patients referred by their GP for a clinical assessment and/or treatment       community and in people’s homes. This is in recognition of the harmful effects that passive
will have that treatment delivered within 18 weeks of the referral. The new Health Centres,             smoking can have and it is hoped to that these guidelines will assist staff members delivering
together with much improved diagnostic support, will enable Bury to deliver these targets for our       services in the community to work in a smoke free environment.
patients. In addition, patients with longer term illnesses will be able to have their conditions
managed and treated in a more familiar and local environment at their own Health Centre, without        Patient Advice and Liaison Service (PALS)
needing to attend hospital outpatients unless their condition requires it.                              The Bury PCT PALS Service continues to provide a useful resource for patients wishing to gain
                                                                                                        advice or information about local NHS services. In the last year 409 new enquiries were dealt with
PCT PERFORMANCE IN KEY FUNCTIONS                                                                        by the service.

Improving Working Lives                                                                                 The main issues dealt with by the service involved access to NHS dentistry and issues relating to
                                                                                                        home oxygen supplies.
Bury PCT has been awarded Improving Working Lives Practice Plus
Status. The PCT has continued to develop staff policies and                                             Outcomes of these contacts to the service:
improvements to ensure that IWL became embedded in the overall                                          •   305 cases were resolved by PALS
culture of the PCT. The Validation team visited the PCT in December                                     •   55 were referred on, usually to formal complaints or PALS in other organisations
2005 and felt that significant progress had been made by the PCT,                                       •   25 required no action
highlighting areas of good practice such as                                                             •   19 cases were unable to be resolved
•   A clear commitment to Improving Working Lives from the Chief                                        •   5 not resolved
    Executive, the Chair, the Non Executive IWL Lead and members
    of the IWL Steering Group.                                                                          The PALS Service is subject to a further phase of developments in 2006/07 with some identified
                                                                                                        improvements being;
•   Flexible working practices which are embedded throughout all areas of the PCT.
                                                                                                        •   To hold regular “drop in” sessions in health centres in each of the sectors
•   An excellent Counselling Advice and Reassurance for Employees (CARE) scheme
                                                                                                        •   To continue to raise awareness of the PALS service, seeking opportunities for presentations
     which provides prompt support to staff.                                                                with community/staff groups
•   Effective communication systems with all staff having access to weekly news bulletins.
•   Staff consultation and involvement events to develop improved service delivery.
•   A comprehensive development programme which is mandatory for most managers.
•   Effective Bullying and Harassment and Equality and Diversity training programmes which
    are both mandatory.
•   A health audit of staff with a resulting action plan to promote healthy working, including stress
    awareness, healthy eating and smoking cessation.
•   Clear support for staff with carer responsibilities.

                                Achieving Meaningful Outcomes                                                                                     Valuing Staff
                                              9                                                                                                        10
Complaints Handling                                                                                  Patient Health Survey
Some issues concerning local NHS services are unable to be resolved through the PALS service         The PCT carries out a Patient Health Survey looking at the health of people in Bury.
and patients will use their right to complain via the established NHS Complaints Process.
                                                                                                     The survey looked at a range of health related items including alcohol use, body weight, diet and
During the reporting period, Bury PCT received 70 written complaints. 31 complaints were in          exercise. The survey of 3500 patients had 63% of questionnaires returned. Reports from the
relation to the PCT and its staff and 39 complaints were in relation to Family Health Services (eg   survey are available on the PCT website.
GPs, Dentists and Pharmacies).
                                                                                                     The results will inform and influence the PCT in a position to improve health care services in the
51% of the complaints were resolved within the 20 day target. Delays in resolving complaints         future, to meet the needs of local people and ensure that services are provided when and where
within the specified timescale were largely related to either the complexity of investigating        they are needed.
complaints (ie relating to more than one aspect of NHS services or relating to services from the
NHS and other agencies), or due to the unavoidable absence of key staff members involved in the
complaints process.                                                                                  Staff Opinion Survey
The PCT is working to improve performance against this key standard. A revised complaints policy     Like all NHS Trusts the PCT carries out an annual survey of staff attitude across the organisation.
and procedure will also flag additional measures to improve complaints monitoring and internal       The 2005 Staff Survey achieved a response rate of 65% which is very similar to 2004 and overall
processes to ultimately allow the PCT to improve services as a result of complaints.                 the PCT remains in a positive position. The PCT scored within the top 20% of PCTs nationally on
                                                                                                     issues such as:
                                                                                                     •   Extent of positive feeling within organisation
Strengthening Patient and Public Involvement
                                                                                                         (communication, staff involvement, innovation
Bury PCT is committed to involving patients, users, carers and the public in improving the quality       and patient care)
and responsiveness of local health services.
                                                                                                     •   Perceptions of effective action from the PCT towards
During the reporting period the PCT undertook a range of activities designed to gain public              violence and harassment
feedback on health service developments and a comprehensive public consultation process took
                                                                                                     •   Staff intentions not to leave jobs
place in relation to the ‘Best For Health’ proposals.
                                                                                                     The PCT will use the findings of the survey to make further
The PCT has now achieved a more robust system of engaging with stakeholders and users of
                                                                                                     improvements towards becoming a model employer.
services, as well as working closely with a wide range of local voluntary and user groups. The
PCTs Patient and Public Involvement (PPI) Forum continues to work with the PCT in ensuring
local views are fed into the planning process.
                                                                                                     Promoting Equality and Diversity
                                                                                                     Significant progress has been made in achieving the PCT’s objectives in relation to promoting
Expert Patient Programme – EPP                                                                       Equality and Diversity. Some of these include;
                                   The Expert Patient Programme is an initiative designed to         •   The PCT’s Race Equality Scheme has been reviewed, and revised.
                                   encourage patients to become more aware of their own health
                                                                                                     •   The PCT’s Equality and Diversity Policy has been reviewed and revised.
                                   and the management of their own conditions. In Bury the
                                   programme has continued to flourish with the appointment of       •   All Directors and Non-Executive Directors have received awareness training on equality and
                                   a dedicated Co-ordinator.                                             diversity.
                                   Presentations about the Expert Patient Programme are              •   Over 85% of staff have so far received the mandatory awareness training on equality and
                                   delivered to patient support groups and the PCT continues to          diversity.
                                   promote the programme via local press coverage.
                                                                                                     •   The monitoring of staff in a range of equality and diversity areas has been significantly
                                  Development plans for the programme include recruitment of             improved.
six Expert Patient Health Trainers, to facilitate six to eight courses per year, plus individual
                                                                                                     •   All staff are required to attend mandatory training on Bullying and Harassment.
                                                                                                     •   The PCT has recently been re-accredited for the disability two ticks award.

                                         Team Working                                                                                  Having A Positive Approach
                                              11                                                                                                  12
Governance and risk management                                                                        Podiatry Services
The PCT's Clinical Governance and Risk Management Teams were integrated in a single                   Podiatry is the study of the lower limb and foot, its function, dysfunction and associated
Directorate during 2005/6. This is placed at the centre of the organisation to further ensure a       pathologies, Developments include:
comprehensive and consistent approach to patient and staff safety and overall organisational          •   Measures to reduce waiting times for patients using a range of initiatives
governance.                                                                                           •   twice weekly “critical diabetic foot” clinics,
The Healthcare Commission is responsible for measuring and reporting to the public the                •   rheumatology foot clinics,
performance of NHS organisations. As part of the Annual Health Check, the PCT's Board made            •   acupuncture for the treatment of painful diabetic neuropathy.
a declaration of compliance with the Standards for Better Health which define the levels of quality
that any patient shoud expect from any NHS organisation.
                                                                                                      Orthoptic Services
The PCT is committed to learning from situations where things do not go as planned. PCT staff
reported 393 incidents during 2005/6, an increase of 13% compared with 2004/5 and each                Orthoptists are concerned with the investigation, diagnosis and treatment of ocular motility and
incident was reviewed for actions to prevent recurrence.                                              problems related to vision in all age groups from newborn to the very elderly. New local
                                                                                                      developments include input into the assessment of stroke patients, a member of staff is now fully
                                                                                                      integrated into the Stroke Team.
Provider Services
                                                                                                      •   Prestwich Walk-In-Centre offers a community based glaucoma screening service.
The Provider Services within Bury PCT aim to deliver high quality easily accessible healthcare to     •   Visual and orthoptic screening of all reception age children is offered.
the population of Bury, working within the PCT’s philosophy of ‘delivering person centred care and    •   An Orthoptist is now working with the Learning Disabilities team.
services’. Here, the achievements of some of the PCTs Provider services are covered.
                                                                                                      •   Low Vision Aid assessments and provision is increasing with sessions now at Tottington
                                                                                                          Health Centre and Prestwich Walk-in Centre, as well as Fairfield General Hospital.
Audiology Services
                                   Audiology evaluates, monitors and determines the nature and        Occupational Therapy Services
                                   type of hearing loss for all ages, providing appropriate hearing
                                   aid amplification and offering individual counselling to enable    The Occupational Therapy Service provides treatment to people with physical disability, to enable
                                   effective communication.                                           them to achieve their maximum level of functional independence. Occupational Therapy is
                                                                                                      provided both in the acute hospital and in the community.
                                   The Audiology department continues to look at new and
                                   innovative ways to speed up waiting times for changeover from      Service developments include:
                                   analogue to digital technology. One of these is the introduction   •   Enhancement of the Falls Prevention Service with the recruitment of a Falls Prevention
                                   of group fittings, which has enabled several patients to be            Occupational Therapist.
                                   issued with digital technology at the same time.
                                                                                                                                         •    A Palliative Care Occupational Therapist has
A new, purpose built Audiology facility has been completed and equipped at Tottington Health                                                  been appointed to provide specialist advice and
Centre. This has enabled patients to be seen locally in the north of the borough to compliment                                                intervention for clients and their carers who
services offered at Whitefield Health Centre.                                                                                                 require palliative care. This will include
                                                                                                                                              rehabilitation in addition to the provision of
Speech & Language Therapy Services                                                                                                            necessary adaptations and equipment that are
                                                                                                                                              required to enable people to maintain living at
In recent years the adult service has seen an increase in activity whilst maintaining waiting list                                            home. An additional Neuro Rehabilitation
standards of two to four weeks. The department has worked with the Stroke Service to improve                                                  Occupational Therapist has been funded to
assessment and treatment in line with National Guidelines. The service has worked with Pennine                                                develop this team and outreach to community.
Acute Trust to establish best practice for patients following Tracheostomy, developing Dysphagia,
and agreeing a pathway for patients following Laryngectomy with a Support Group planned.              •   As part of the developments within Intermediate Care an Occupational Therapy post has been
                                                                                                          funded to provide rehabilitation to people who attend Day Care. This post also provides
                                                                                                          follow-up in the community for Intermediate Care clients who have been discharged home
The Children’s Service continues to provide a service for children with communication difficulties.       following their six-week rehabilitation programme.
This year funding has been secured to pilot speech & language therapy through the new
Children’s Centres. This work is concentrating on prevention of later potential speech & language

                                 Being Open and Transparent                                                                              Having a Patient Focus
                                             13                                                                                                    14
Community Paediatric Nursing Team                                                                     Key Performance of Commissioned Services
A new Children’s Community Nursing team set up in 2006 is being developed to improve health           Hospital Activity
services so that children, young people and families in Bury have access to high quality integrated
                                                                                                      During the year there were 4,512 patients who received planned inpatient treatment (4,553 in the
care as close to or in the family home as possible. The team is currently based in the YPAS
                                                                                                      previous year). 3,320 (3,456 in the previous year) of these patients received their treatment at the
building on Parsons Lane and take referrals from multi disciplinary professionals.
                                                                                                      Pennine Acute Hospitals NHS Trust, which includes the Fairfield General Hospital site.
                                                                                                      •   The majority of these cases fell into the medical specialty areas of trauma and orthopaedics,
District Nursing                                                                                          general surgery and ear, nose and general medicine.
The District Nursing service provides holistic nursing care to housebound patients.                   There were 15,248 patients who received elective day case treatment (14,307 in the previous
                                                                                                      year). 12,131, (11,493 in the previous year) of these patients received their treatment at
Over the last 12 months the District Nursing service has had a total of 19,000 patient contacts.
                                                                                                      Pennine Acute Hospitals NHS Trust.
They have treated a variety of patients from those requiring terminal care, chronic disease
management and short term intervention and diagnostics and treatment.                                 •   The majority of these cases fell into medical specialty areas of areas of general surgery,
                                                                                                          urology and general medicine.
The District Nursing service is responding to the change agenda and developing its service to
respond to the National and Local drivers to secure and deliver care closer to home.                  There were 7,413 patients who received elective inpatient treatment (7,165 in the previous
                                                                                                      year). 4,843, (4,837 in the previous year) of these patients received their treatment at Pennine
                                                                                                      Acute Hospitals NHS Trust.
International Nurses Day
                                                                                                      •   The majority of these cases fell into medical specialty areas of areas of general surgery, ENT
May 12th is internationally recognised as ‘Nurses Day’, and is indeed the birthdate of a most             and Trauma and Orthopaedics.
famous nurse ‘Florence Nightingale’. Bury Primary Care Trust held a special event on this day to
                                                                                                          18,015 patients received emergency hospital treatment (17080 in the previous year), of which
celebrate its nursing staff. The event followed the Theme ‘Nurses Working in Partnership’, and it
                                                                                                          15,065 were treated at Pennine Acute Hospitals NHS Trust (14,423 in the previous year).
was the perfect opportunity for the PCT to recognise that nurses do work in partnerships across
different agencies pulling together different aspects of patient centred care.                        •   The majority of these cases fell into the medical specialty areas of areas of general medicine,
                                                                                                          general surgery, obstetrics, and paediatrics.
The event had a number of keynote speeches from senior staff within the PCT and a number of
presentations were given on the theme of Partnership Working.                                         Performance on waiting lists/times
                                                                                                      •   Inpatients/daycases    - 9 month target achieved - No 9 month waiters during the year.
                                                                                                                                 - 6 month target of zero by December 05 achieved.
                                                                                                      •   Outpatients            - 13 week target achieved - No 17 week waiters during the year.
                                                                                                                                 - 13 week target of zero by December 05 achieved.
                                                                                                      •   Numbers of patients waiting 3-6 months reduced to 658 by March 06. (821 in the previous
                                                                                                          year, equates to a yearly reduction of 20%).
                                                                                                      •   Numbers of patients waiting 8-11 weeks waiters (0<3 months) 2567, 05/06 waiters (0<3
                                                                                                          months) 3003
                                                                                                      •   A&E 98% target achieved
                                                                                                      •   GP/PCP targets GP 99.63% and PCP 100%

                               Achieving Meaningful Outcomes                                                                                    Valuing Staff
                                            15                                                                                                       16
The PCT Board                                                          Board Members   The Professional Executive Committee
                                                                         2005-06       The Professional Executive Committee (PEC) provides the opportunity for professional input into
The formal PCT Management Structure comprises a Board, a          1          2
                                                                                       the planning and commissioning of health services. It is through the PEC that plans and proposals
Provder Board, a Professional Executive Committee (PEC), plus                          are discussed and turned into action.The PEC is made up of NHS Doctors, Nurses and
two statutory committees, the Audit Committee and the                                  Therapists, the Directors of Adult and Childrens Services plus three PCT Executive Directors the
Remuneration Committee.                                                                Chief Executive, Director of Finance & Commissioning and Director of Public Health. During 2005
                                                                                       the PEC embraced two further representatives from the dental and the Pharmeceutical
The PCT Board is responsible for strategic planning and                                professions.
development of services in Bury. Membership includes seven
Non-Executive Directors (including the Chair of the PCT), three                        Dr Derek Fletcher          PEC Chair
                                                                  3          4         Dr Rak Thaker              PEC Vice Chair, GP Member
members of the Professional Executive Committee (including the
PEC Chair, and Nurse Member) and three Executive Directors                             Dr Kumar Kotegaonkar       GP Member
(including the Chief Executive, Director of Finance &                                  Dr Jerry Martin            GP Member, Clinical Governance Lead
Commissioning and Director of Public Health).                                          Dr Iqbal Qureshi           GP Member
                                                                                       Mrs Judith Willan          Nurse Member
                                                                                       Mrs Maria Woodhouse        Nurse Member
                                                                  5          6         Ms Claire Maguire          Other Healthcare Professional
PCT Board members during 2005-06                                                       Ms Elizabeth Moore         Other Healthcare Professional
1. Mrs. Hilda Harvey – Chair                                                           Ms Eleni Ioannides         Social Services Representative (Childrens services)
2. Dr. Derek Fletcher – PEC Chair                                                      Ms Pat Horan               Social Services Representative (Adult Services)
                                                                                       Mr Martin McLellan         Dental Member (from 1.11.05 Dr A Kravitz until 31.10.05)
3. Mr. Evan Boucher – Chief Executive (retired 31.03.2006)
                                                                                       Mr Howard Hughes           Pharmeceutical Member
4. Mrs. Helen Humphreys – Non-Executive Director (until May 05)
                                                                  7          8         Mr Stephen Mills           Director of Finance and Commissioning
5. Mr. James McDonald – Vice Chair                                                     Dr Peter Elton             Director of Public Health
6. Mr. James Rogers – Non-Executive Director
7. Cllr John Byrne – Non-Executive Director                                            PCT Provider Board
8. Mrs Janet Turner – Non-Executive Director                                           In October 2005 the PCT introduced a Provider Board to oversee and progress the PCTs Provider
9. Mrs. Maria Woodhouse – PEC Nurse Member                                             Services in line with Commissioning a Patient Led NHS.
                                                                  9          10
10. Mr. Stephen Mills – Director of Finance and Commissioning                          Mr Robin Halward           Chair, Non Executive Member
11. Mr. Robin Halward – Non-Executive Director                                         Mrs Hilda Harvey           Non Executive Member (and PCT Chair)
12. Dr. Jerry Martin – PEC member – Clinical Governance                                Mr Stephen Mills           Director of Finance and Commissioning
                                                                                       Cllr John Byrne            Non Executive Member
13. Dr. Peter Elton – Director of Public Health
                                                                                       Ms Claire Maguire          PEC Member
Secretary to the Board – Mrs. Alison Mitchell                                          Dr Jerry Martin            PEC Member (Clinical Governance Lead)
                                                  11              12         13

                                                                                       Audit Committee
                                                                                       Members of the Audit Committee receive advice from the Director of Finance & Commissioning,
                                                                                       External and Internal Audit. The Internal Audit Manager also acts as the Local Counter Fraud
                                                                                       Specialist for the PCT. The Committee reviews the effectiveness of internal control and risk
                                                                                       management and meets at least three times annually.
                                                                                       The Committee is authorised by the Board to investigate any activity within its terms of reference,
                                                                                       which are available in full from the Audit Committee Secretary, Miss Carolyn Frearson
                                                                                       (Tel: 0161 762 3129).

                                         Team Working                                                                    Having A Positive Approach
                                              17                                                                                    18
Members of the Audit Committee                                                                  Annual Accounts for the year ended 31st March 2006
Cllr. John Byrne (Chair, Non-Executive Director)                                                Statement by Director of Finance
Mr. James McDonald (Non-Executive Director)
Mr. James Rogers (Non-Executive Director)                                                       The annual accounts follow accounting policies and timetables as prescribed by the
Mr. Robin Halward (Non-Executive Director)                                                      Secretary of State for Health and approved by Treasury, they show an underspend of £369,000
                                                                                                for the year.
Mr. Steven Mills (during 2005/06)
                                                                                                The financial strategy of the organisation is made up of the following three main strands
Miss. Carolyn Frearson (Secretary)
                                                                                                1)   Manage within available resources.
                                                                                                2)   Maximise efficiences and productivity from doing things differently.
Remuneration Committee
                                                                                                3)   Maximise the value of every pound spent for economy, efficiency and effectiveness.
The Remuneration Committee advises the PCT about appropriate remuneration, terms and
conditions of service for Directors and senior staff.                                           The Primary Care Trust has entered into two arrangements with Bury Metropolitan Council to pool
                                                                                                budgets for Learning Disability services and Integrated Community Equipment Store(ICES).
                                                                                                Under the arrangement funds are pooled under s31 of the Health Act 1999, the pool is hosted by
Members of the Remuneration Committee                                                           Bury MBC and the PCT makes contributions to the pool for services to be provided as part of its
                                                                                                commissioning role.
Mr. James McDonald (Chair, Non-Executive Director)
Mrs. Helen Humphreys (Non-Executive Director until May 2005)
Mrs. Hilda Harvey (PCT Chair)
Mrs. J Turner (from May 2005)
Mrs. Alison Mitchell (Board Secretary)

                                                                                                Signed ……………………………………………..Finance Director
Remuneration Report
For the purpose of this report the Senior Managers of the PCT are those whose remuneration
details are stated within the annual accounts on page 29. Full terms of reference for the
Remuneration Committee are available from the PCT upon request from the Board Secretary.        Date       19th July 2006.

Managers within the PCT do not have Performance conditions in their contracts, and the
Remuneration Committee agrees an appropriate uplift for managers as part of their remit. Any
Special contractual arrangements for senior managers would also be agreed by the Remuneration

Register of Interests
Full details of remuneration for members of the PCT Board, Professional Executive Committee
and of PCT senior staff are given on page 29. All Executive Directors of the PCT have been in
post since the PCT was established in April 2002.
Register of interests of Board Members in 2005-06 are available upon request from the Board
Secretary of the PCT.

                                Being Open and Transparent                                                                           Having a Patient Focus
                                            19                                                                                                 20
External Auditors                                                                                 Operating Cost Statement 2005/06
The PCT's auditors for the financial year 2005/06 were the Audit Commission.                                                                              2005/06     2004/05
The cost of work carried out by the external auditors for the year ended 31 March 2005 was                                                                  £000        £000
£98,000. This was the annual fee inclusive of VAT in respect of auditing annual accounts and
                                                                                                  Commissioning Gross Operating Costs                     315,928     291,057
assessing the adequacy of the PCT's arrangements to manage the financial aspects of corporate
governance.                                                                                                       Less: Miscellaneous Income              (118,455)   (110,283)
All members of the audit team are independent of the PCT Board and staff members. Each year                       Commissioner Net Operating Costs        197,473     180,774
the audit team provide a statement in support of requirements for their independence and
                                                                                                  Providing       Gross Operating Costs                    19,957      16,924
                                                                                                                  Less: miscellaneous income               (2,087)     (1,938)
Summary of Results of the Primary Care Trust
For the period ended 31st March 2006                                                                              Provider Net Operating Costs             17,870      14,986
The organisation has 4 key financial targets.                                                     Net Operating Costs before interest                     215,343     195,760
Achievement Of Operational Financial Balance.                                                                     Interest Receivable                        0           0
For 2005/06 the PCT were able to satisfy this target by achieving a £369,000 underspend against                   Interest Payable                           0           0
the Revenue Resource Limit.
                                                                                                  Net Operating cost for the Financial Year               215,343     195,760
There was also an underspend against the Capital Resource Limit of £1,000.
Provider Full Cost Recovery
The PCT were obliged to ensure that the Provider arm of the organisation was not subsidised by
the Commissioner arm.
The Full Cost Recovery duty was achieved by the Provider Services arm.
Financing Limit
The PCT should live within a defined level of cash for each year, this was achieved by Bury PCT
in 2005/06.
Achieving the Better Payment Practice Code Target
The BPPC target is described and performance expressed in section 3 page 28 of the Annual
Management Costs.
The Department of Health provide PCTs with a comprehensive definition of NHS Management
Costs. Details of the Management Costs associated with Bury PCT are given on page 28.
Financial Support
During 2005/2006 Bury PCT gave £1,756k financial support to the Strategic Health Authority. Of
the £1,756k, £1,500k was PCT funds and the remaining balance of £256k relates to host services.
This will be repaid in 2006/2007.

                               Achieving Meaningful Outcomes                                                                              Valuing Staff
                                            21                                                                                                 22
Balance Sheet as at 31st March 2006                                                         Cash Flow Statement for the year ended 31st March 2006
                                                            Closing         Opening                                                                         2005/6                  2004/5
                                                            Balances        Balances                                                               £000         £000 £000                £000
                                                             2005/6          2005/6         OPERATING ACTIVITIES
                                                             £000            £000           Net cash outflow from operating activities                       (218,142)               (195,044)
FIXED ASSETS                  Intangible assets                         0               6   SERVICING OF FINANCE:
                              Tangible assets                   10,373            9,759     Interest paid                                              0                       0
                              Investments                               0               0   Interest received                                          0
TOTAL FIXED ASSETS                                              10,373            9,765     Interest element of finance leases                         0                       0
CURRENT ASSETS                Stocks and work in progress              51              20   Net cash inflow/(outflow) from servicing of finance                        0                     0
                              Debtors                            2,021            3,157     CAPITAL EXPENDITURE
                              Cash at bank and in hand                 28              64   Payments to acquire intangible assets                      0                     (11)
TOTAL CURRENT ASSETS                                             2,100            3,241     Receipts from sale of intangible assets                    0                       0
CREDITORS : Amounts falling due within one year                (12,477)        (14,789)     Payments to acquire tangible fixed assets             (1,351)                   (639)
NET CURRENT ASSETS / (LIABILITIES)                             (10,377)        (11,548)     Receipts from sale of tangible fixed assets                0                       0
TOTAL ASSETS LESS CURRENT LIABILITIES                                 (4)       (1,783)     Payments to acquire fixed asset investments                0                       0
Creditors: Amounts falling due after more than one year                 0               0   Receipts from sale of fixed asset investments              0                       0
Provisions for liabilities and charges                          (2,600)         (5,052)     Net cash inflow/(outflow) from capital expenditure                 (1,351)                   (650)
TOTAL ASSETS EMPLOYED                                           (2,604)         (6,835)     Net cash inflow/(outflow) before financing                       (219,493)               (195,694)
FINANCED BY:                  General Fund                      (5,317)         (9,327)     FINANCING
                              Revaluation reserve                2,713            2,492     Net Parliamentary Funding                             219,457               192,656
                              Donated asset reserve                     0               0   Other capital receipts surrendered                         0                       0
                              Government grant reserve                  0               0   Capital grants received                                    0                       0
                              Other reserves                            0               0   Capital element of finance lease rental payments           0                       0
TOTAL CAPITAL AND RESERVES                                      (2,604)         (6,835)     Cash transfers (to)/from other NHS bodies                  0                       0
                                                                                            Net cash inflow/(outflow) from financing                          219,457                 192,656
                                                                                            Increase/(decrease) in cash                                              (36)              (3,038)

                                         Team Working                                                                        Having A Positive Approach
                                              23                                                                                        24
Statement of Recognised Gains and Losses for the year                                        Prescribing costs                                               31,808      30,157
ended 31st March 2006                                                                        GMS/PMS/APMS/PCTMS                                              23,018       19,393
                                                               2005/06         2004/05       Pharmaceutical Services                                              0             1
                                                                £000            £000         Local Pharmaceutical Service Pilots                                 67            16
Fixed asset impairment losses                                              0             0   General Dental Services                                            101           134
Unrealised surplus (deficit) on fixed asset                                                  General Ophthalmic Services                                      1,291        1,276
revaluations/indexation                                                  284       1,007     Supplies and services - clinical                                 1,744        1,347
Increase in the donated asset reserve and government grant                                   Supplies and services - general                                    593           502
reserve due to receipt of donated and government                                             Establishment                                                    1,386        1,116
granted assets                                                             0             0   Transport                                                           19            16
Addition/(Reductions) in the General Fund due to the                                         Premises                                                         1,254        1,518
transfer of assets from/(to) NHS bodies and the                                              Bad debts                                                            0             6
Department of Health                                                       0             0   Depreciation and amortisation                                      411           392
Additions/(reductions) in "other reserves"                           (63)                0   Fixed asset impairments and reversals                                0             0
Recognised gains and losses for the financial year                       221       1,007     (Profit)/loss on disposal of fixed assets                            0             0
Prior period adjustment - other                                            0             0   Cost of capital charge                                           (167)         (363)
                                                                                             Audit fees                                                          98            96
Gains and losses recognised in the financial year                        221       1,007
                                                                                             Other auditor's remuneration                                         0             0
                                                                                             Clinical negligence costs                                           39            16
Analysis of gross operating costs                                                            Other finance costs - unwinding of discount                         58            35
                                                               2005/06         2004/05       Change in the discount rate on provisions                          630           N/A
                                                                £000            £000         NHS Trust Impairments                                                0             0
Goods and services from other Primary Care Trusts                                            Other                                                            1,874        3,012
Healthcare                                                          5,816          5,063     Total                                                          335,885      307,981

Non Healthcare                                                      1,161          1,486
Total                                                               6,977          6,549     Analysis Of Miscellaneous Income
                                                                                                                                                         2005/06      2004/05
Goods and services from other NHS bodies
excluding Foundation Trusts                                                                                                                               £000         £000
                                                                                             Fees and Charges                                                     2           32
Healthcare                                                        231,654         218,020
                                                                                             PDS Pilots dental charge income                                    511            0
Non Healthcare                                                      1,030            566
                                                                                             Prescription Charge Income                                           0            0
Total                                                             232,684         218,586    Strategic Health Authorities                                     1,137        1,207
Goods and Services from Foundation Trusts                                424         343     NHS Trusts                                                       1,454        1,480
Purchase of healthcare from non-NHS providers                       9,788          5,913     Foundation Trusts                                                  153          123
Social Care from independent providers                                     0             0   Primary Care Trusts for Drug Action Teams                            0            0
                                                                                             Primary Care Trusts - other                                      1,006          971
Expenditure on Drugs Action Teams                                          0             0
                                                                                             Primary Care Trusts - Lead Commissioning Income                115,325      107,016
Non-GMS services from GPs                                                  0             0
                                                                                             English RAB Special Health Authorities                              14           30
PDS Pilots                                                          3,188          1,496     Other English Special Health Authorities/CGA Bodies                  0            0
PCT Board members' costs                                                 464         426     Department of Health - SMPTB                                         0            0
PCT Executive Committee non-officer members' costs                       117         115     Department of Health - other                                         0           76
Staff costs                                                        18,019         15,883     Income for Trust Impairment                                          0            0

                                  Being Open and Transparent                                                                    Having a Patient Focus
                                              25                                                                                          26
Local Authorities                                                195         0    Management Costs
Patient Transport Services                                         0         0                                                                          2005/6              2004/5

Education, Training and Research                                   0         0    Management costs                                            £000               3769        3298
Non NHS: Private Patients                                          0         0    Weighted Population                                                         182358        179168
Non-NHS: Overseas Patients (non-reciprocal)                        0         0    Management cost per head of weighted population              £                 20.67      18.41
Road Traffic Act                                                   0         0
Other Non-NHS patient care services                               51        21
Charitable and other contributions to expenditure                  0         0    Retirements Due to ill-health
Transfer from the donated asset reserve                            0         0    During 2005/06 there were 6 early retirements from the Primary Care Trust on the grounds of ill-
Transfer from the Government Grant reserve                         0         0    health (2004/05 1).

Other income                                                     694      1,265   The estimated additional pension liabilities of these ill-health retirements (calculated on an
                                                                                  average basis and borne by the NHS Pension Scheme) will be £389,314.17 (2004/05 £7,639).
TOTAL MISCELLANEOUS INCOME                                    120,542   112,221

                                                                                  Better Payment Practice Code - measure of compliance
                                                                                  The prompt payment code is summarised as follows:

                                                                                  a) Target : Pay all non -NHS trade creditors within 30 days of receipt of goods or a valid invoice
                                                                                  (whichever is later) unless other payment terms have been agreed.

                                                                                  b) Compliance : authorise payable order schedules to take money from the PCT's bank account
                                                                                  within 30 days (or date and issue cheque within that period).

                                                                                  The notional target set for Primary Care Trusts is to achieve 95% in each category.

                                                                                  This organisation has achieved 94% of its target with regards to both the number of invoices paid
                                                                                  and the value of invoices paid.

                                                                                                                                            2005/06                      2004/05

                                                                                  Non-NHS Creditors                                 Number           £000s        Number       £000s

                                                                                  Total bills paid in the year                       17,211          24,561        15,299      19,864

                                                                                  Total bills paid within target                     16,198          23,173        13,560      17,921

                                                                                  Percentage of bills paid within target             94.11%        94.35%         88.63%       90.22%


                                                                                  NHS Creditors                                     Number           £000s
                                                                                                                                                                   This information
                                                                                  Total bills paid in the year                        1,628        242,395         was not provided
                                                                                  Total bills paid within target                      1,469        241,240         in 2004/2005

                                                                                  Percentage of bills paid within target             90.23%        99.52%

                              Achieving Meaningful Outcomes                                                                 Valuing Staff
                                           27                                                                                    28
Operating Leases                                                                                                                                                                  Pension entitlements
                                                                                                                                                                                  Name and title                                              Real increase    Lump sum        Total accrued       Lump sum          Cash            Cash      Real increase      Employer’s
Operating expenses include:                                                                            2005/06                  2004/05                                                                                                       in pension at     at age 60     pension at age       at age 60      Equivalent      Equivalent      in Cash         contribution

                                                                                                        £000                      £000                                                                                                            age 60       related to           60 at          related to      Transfer         Transfer    Equivalent     to stakeholder
                                                                                                                                                                                                                                                              real increase                    accrued pension at Value at          Value at      Transfer          pension
Hire of plant & machinery                                                                                         2                                 5                                                                                                         in pensions      31 March 2006     31 March 2006     31 March        31 March        Value          (rounded to

Other operating lease rentals                                                                                    92                                31                                                                                           (bands of      (bands of          (bands of        (bands of         2006            2005                         nearest £00)
                                                                                                                                                                                                                                                “£2,500)”       “£2,500)”         “£5,000)”        “£5,000)”
Total                                                                                                            94                                36                                                                                              £000           £000              £000             £000            £000            £000          £000                £

                                                                                                                                                                                  Mr Evan Boucher Chief Executive                               2.5 To 5.0                    Consent Withheld                   Not Applicable Consent Withheld Not Applicable         0
Annual commitments under non - cancellable operating leases are:                                                                                                                  Mr Stephen Mills Director Of Finance & Commissioning           0 To 2.5       5.0 To 7.5        35 To 40         105 To 110         608             551              30               0

                                                                                    2005/06                                                       2004/05                         Dr Peter Elton Director Of Public Health                       0 To 2.5       0 To 2.5          35 To 40         115 To 120         650             620              10               0
                                                                                                                                                                                  Mrs Anne Coates Director of Primary Care & Development         0 To 2.5       2.5 To 5.0        15 To 20          45 To 50          199             175              14               0
                                                                   Land and                            Other                    Land and                        Other             Mrs Roslyn Walker Clinical Director Of Therapies               0 To 2.5       2.5 To 5.0        25 To 30          75 To 80          451             414              19               0
                                                                   Buildings                           Leases                   Buildings                     Leases              Mrs Elizabeth Moore PEC Member                                 0 To 2.5       0 To 2.5          10 To 15          35 To 40          164             163              0                0

                                                                                                        £000                      £000                                            Mrs Judith Willan PEC Member                                   0 To 2.5       0 To 2.5          10 To 15          30 To 35          188             188              0                0
                                                                                                                                                                                  Mrs Maria Woodhouse PEC Member                                 0 To 2.5       0 To 2.5          10 To 15          30 To 35          169             148              12               0
Operating leases which expire:                                                                                                                                                    Mr Mark Campbell Director Clinical Governance                  0 To 2.5       2.5 To 5.0         5 To 10          25 To 30          124             101              14               0

Within 1 year                                                              0                                      0                                 0                         7

Between 1 and 5 years                                                     81                                      0                                 0                         0   Note

After 5 years                                                              2                                      0                                72                         0   The Cash Equivalent Transfer in respect of Dr Peter Elton was incorrectly declared in 2004/05

Total                                                                     83                                      0                                72                         7

                                                                                                                                                                                  Related Party Transactions

Salary and Pension entitlements of Senior Managers
                                                                                                                                                                                  Bury Primary Care Trust is a body corporate established by order of the Secretary of State for
Salary And Other Renumeration                                                                 2005-06                                              2004-05
Name and title                                                           Salary                Other             Benefits         Salary            Other           Benefits      During the year none of the Board Members or members of the key management staff or parties
                                                                        (bands of        remuneration             in kind        (bands of       remuneration           in kind
                                                                        “£5,000)”         (bands of              (bands of       “£5,000)”        (bands of         (bands of
                                                                                                                                                                                  related to them has undertaken any material transactions with Bury Primary Care Trust
                                                                                              “£5,000)”          “ £1,000)”                       “£5,000)”        “ £1,000)”
                                                                          £000                  £000               £000            £000             £000                 £000     The Department of Health is regarded as a related party. During the year Bury Primary Care Trust
                                                                                                                                                                                  has had a significant number of material transactions with the Department, and with other entities
Mrs Hilda Harvey Chairperson                                            20 To 25                 0                    0           15 To 20              0                 0
Mr James McDonald Vice Chairperson                                       5 To 10                 0                    0           5 To 10               0                 0
                                                                                                                                                                                  for which the
Mr James Rogers Non Executive Director                                   5 To 10                 0                    0           5 To 10               0                 0
Mr John Byrne Non Executive Director                                     5 To 10                 0                    0           5 To 10               0                 0       Department is regarded as the parent Department, viz:
Mrs Janet Turner Non Executive Director
Mrs Helen Humphreys Non Executive Director
                                                                         5 To 10
                                                                         0 To 5
                                                                                                                                  5 To 10
                                                                                                                                  5 To 10
                                                                                                                                                                                                                                                                                                                                 2005/06 2004/05
Mr Robin Halward Non Executive Director                                  5 To 10                 0                    0            0 To 5               0                 0
Mrs Elizabeth Moore PEC Member                                           5 To 10                 0                    0           5 To 10               0                 0
                                                                                                                                                                                                                                                                                                                                    £000                £000
Mrs Judith Willan PEC Member                                             5 To 10                 0                    0           5 To 10               0                 0
Dr Jerry Martin PEC Member                                          Consent Withheld             0                    0       Consent Withheld          0                 0       Pennine Acute Hospitals NHS Trust                                                                                                                75,323              69,965
Dr Derek Fletcher PEC Member                                            40 To 45                 0                    0           35 To 40              0                 0
Dr Rakesh Thaker PEC Member                                             10 To 15                 0                    0           10 To 15              0                 0       Greater Manchester Ambulance Services NHS Trust                                                                                                  59,319              49,703
Dr Kumar Kotegaonkar PEC Member                                     Consent Withheld             0                    0           10 To 15              0                 0
Dr Mohammed Iqbal Qureshi PEC Member                                    10 To 15                 0                    0           5 To 10               0                 0       Central Manchester &
Mrs Maria Woodhouse PEC Member                                           0 To 5                  0                    0           5 To 10               0                 0       Manchester Childrens University Hospitals NHS Trust                                                                                              38,370              35,465
Mrs Eleni Ioannides PEC Member                                           5 To 10                 0                    0           5 To 10               0                 0
Mrs Claire Maguire PEC Member                                           10 To 15                 0                    0           10 To 15              0                 0       South Manchester University Hospitals NHS Trust                                                                                                  30,943              29,703
Mr Howard Hughes Co-opted PEC Member                                     5 To 10                 0                    0            0 To 5               0                 0
Dr Anthony Stephen Kravitz Co-opted PEC Member                           0 To 5                  0                    0           5 To 10               0                 0       Pennine Care NHS Trust                                                                                                                            9,852                 9,667
Mrs Pat Horan                                                            5 To 10                 0                    0              0                  0                 0
Mr Martin McLellan                                                       0 To 5                  0                    0              0                  0                 0       Salford Royal Hospitals NHS Trust                                                                                                                 5,697                 5,048
Mr Evan Boucher Chief Executive                                        105 To 110                0                    0          100 To 105             0                 0
Mrs Roslyn Walker Clinical Director Of Therapies                        60 To 65                 0                    0           55 To 60              0                 0
Mrs Anne Coates Director of Primary Care & Development                  65 To 70                 0                    0           65 To 70              0                 0
Dr Peter Elton Director Of Public Health                               100 To 105                0                    0         100 To 105              0                 0
Mr Stephen Mills Director Of Finance & Commissioning                    85 To 90                 0                    2           80 To 85              0                 4
Mr Mark Campbell Director Clinical Governance                           55 To 60                 0                    1           50 To 55              0                 4

Mrs Pat Horan                                                        Commenced 01/05/2005
Mr Martin McLellan                                                   Commenced 17/10/2005

                                                                    Team Working                                                                                                                                                                   Having A Positive Approach
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In addition, the Primary Care Trust has had a significant number of material transactions with other   Staff Costs and Numbers
Government Departments and other central and local Government bodies.
Most of these transactions have been with Bury Metropolitan Borough Council in respect of joint                                                                2005/06                2004/05
initiatives.                                                                                                                                                 Permanently            Permanently
                                                                                                                                                        Total Employed Other   Total Employed Other
Related Party relationships of a personal nature were
Mr John Byrne, Non Executive Director is a member of Bury Metropolitan Council.
Mrs Eleni Ioannides, PEC Member is a Director of Bury Metropolitan Council.                            Staff costs                                     £000      £000   £000    £000    £000    £000
Mrs Pat Horan, PEC Member is a Director of Bury Metropolitan Council.
                                                                                                       Salaries and wages                            19,439    17,830   1,609 15,150   13,649   1,501
Mrs Claire Maguire, PEC Member is an employee of Pennine Care NHS Trust.
                                                                                                       Social security costs                           1,222    1,222      0   1,018    1,018      0
The following General Practitioners are Professional Executive Members as well as being
partners in various local General Practice Partnerships/ Consortiums etc. the total value of which     Employer contributions to NHSPA                 2,061    2,061      0   1,732    1,732      0
is included.
                                                                                                       Other pension costs                              266      266       0     99       99       0

                                                                  2005/06           2004/05
                                                                   £000               £000             Total                                         22,988    21,379   1,609 17,999   16,498   1,501
Dr J Martin            Drs NJC Martin, CA Cornwell,
                       SK Kirkham, RA Stokes,
                       JP Watts & CA McKinnon
                                                                                                       Staff Numbers                                 Number Number Number Number Number Number
                       Tottington Health Centre                     975               894

Dr D Fletcher          Drs DP Fletcher & PF Fletcher                                                   Medical and dental                                10       10       0     15       15       0
                       Minden Medical Centre                        494               427
                                                                                                       Ambulance staff                                    0        0       0      0        0       0

Dr R Thaker            Drs RK Thaker, KK Thaker,                                                       Administration and estates                       241      213      28    194      183      11
                       BK Thaker & AJ Rimmer
                       Knowsley Medical Centre                      546               507              Healthcare assistants & other support staff        9        9       0      8        8       0

                                                                                                       Nursing, midwifery & health visiting staff       302      291      11    300      268      32
Dr K Kotegaonkar       Drs KS Kotegaonkar, MK Kotegaonkar,                                             Nursing, midwifery & health visiting learners      0        0       0      0        0       0
                       CM Lal & BP Halder
                       Spring Lane Surgery, Radcliffe               530               443              Scientific, therapeutic and technical staff      115       111      4     93       93       0

                                                                                                       Social Care staff                                  0        0       0      0        0       0
Dr M Qureshi*          Drs MI Qureshi, D Nicholsby, &
                       Dr AJ Behrana                                                                   Other                                              0        0       0      0        0       0
                       Blackburn Street Health Centre               565               462

Note:                                                                                                  Total                                            677      634      43    610      567      43
*Dr Qureshi comparative figures are for part year only
Bury PCT has not received revenue payments from its own charitable funds. These funds are
administered on behalf of the PCT by Pennine Acute NHS Trust

                                 Being Open and Transparent                                                                                  Having a Patient Focus
                                             31                                                                                                        32
                                                                                                                                      The directors are required under the National Health Service Act 1977 to prepare accounts for each financial year. The Secretary
The Secretary of State has directed that the Chief Executive should be the Accountable Officer to the organisation. The relevant      of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the
responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health.       organisation and the net operating cost, recognised gains and losses and cash flows for the year. In preparing these accounts,
These include ensuring that:                                                                                                          Directors are required to:

                                                                                                                                      i. apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury;
- there are effective management systems in place to safeguard public funds and assets and assist in the implementation of
  corporate governance;                                                                                                               ii. make judgements and estimates which are reasonable and prudent;

- value for money is achieved from the resources available to the Primary Care Trust;                                                 iii. state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained
                                                                                                                                      in the accounts.
- the expenditure and income of the Primary Care Trust has been applied to the purposes intended by Parliament and conform
  to the authorities which govern them;                                                                                               The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the
                                                                                                                                      financial position of the organisation and to enable them to ensure that the accounts comply with requirements outlined in the
- effective and sound financial management systems are in place; and                                                                  above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the health authority
                                                                                                                                      and hence for taking reasonable steps for the prevention of fraud and other irregularities.
- annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give
  a true and fair view of the state of affairs as at the end of the financial year and the net operating cost, recognised gains and   The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the
  losses and cash flows for the year.                                                                                                 financial statements.

                                                                                                                                      By order of the board.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an
Accountable Officer.

                                                                                                                                      Dated 19.07.06 Signed.....................................................Chief Executive

Signed..........................................................................................Chief Executive

Dated 19.07.06

                                                                                                                                      Dated 19.07.06 Signed .....................................................Finance Director

                                                         Achieving Meaningful Outcomes                                                                                                                    Valuing Staff
                                                                      33                                                                                                                                       34
                                            Statement on Internal Control 2005/06                                                   A full copy of the statement of Internal Control is available from the PCT in request. Tel 0161 762 3126

                                                   Bury Primary Care Trust                                                          Independent Auditors’ Report to the Directors of the Board of Bury Primary Care Trust

1. Scope of Responsibility                                                                                                          I have examined the summary financial statements set out on pages 20 to 35.
The Board is accountable for internal control. As Accountable Officer and Chief Executive of this Board I have responsibility for
                                                                                                                                    This report is made solely to the Board of Bury Primary Care Trust in accordance with Part II of the Audit Commission Act 1998
maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives.
                                                                                                                                    and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of Auditors and of Audited Bodies
I also have responsibility for safeguarding the public funds and the assets of the organisation.
                                                                                                                                    prepared by the Audit Commission.
As Chief Executive of Bury Primary Care Trust (PCT) I am accountable to the Chair and Non-Executive Members of the Board of
                                                                                                                                    Respective responsibilities of Directors and auditors
Directors for the management and performance of the PCT.

As a member of the Board of Directors, I share equal accountability with the Chair, Non-Executive and Executive Directors for the   The Directors are responsible for preparing the Annual Report. My responsibility is to report to you my opinion on the consistency
performance and probity of the PCT.                                                                                                 of the summary financial statements within the Annual Report with the statutory financial statements. I also read the other
                                                                                                                                    information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or
Partnership working with other Bury organisations is effected through:                                                              material inconsistencies with the summary financial statements.
• Bury Local Strategic Partnership                                        • Bury Health Partnership Group
• Local Implementation Teams (LITs)                                       • Hospital Site Manager/PCT Chief Executive Meetings      Basis of opinion

Partnership working with Greater Manchester organisations, including the Greater Manchester Strategic Health Authority              I conducted my work in accordance with Bulletin 1999/6 ‘The auditors’ statement on the summary financial statement’ issued by
(GMSHA) is effected through:                                                                                                        the Auditing Practices Board.
• Greater Manchester Chief Executive Forum                                • Greater Manchester PCT Chief Executives’ Meetings
• Greater Manchester PCT Executive Directors’ Meetings                    • Joint Collaborative Commissioning Leads’ Meetings
• North East Sector (of Greater Manchester) Strategy Boards               • Association of Greater Manchester PCTs                  In my opinion the summary financial statements are consistent with the statutory financial statements of the PCT for the year ended
                                                                                                                                    31 March 2006.
In addition, comprehensive reporting arrangements are in place to demonstrate our performance to GMSHA through our Local
Delivery Plan, Business Plan and Annual Accountability Agreement.

The process of internal control has been maintained and reviewed within the following framework, particularly in respect of:

• The Board receives the reports on a bi-monthly basis as the primary document for assessing compliance with national and local
targets, and also provides an overview of all major operational and governance issues. It also receives and endorses key internal
                                                                                                                                    Name:     Jackie Bellard                                                   Date: 15 September 2006
and external reports that demonstrate the adequacy of the internal control function
                                                                                                                                    Title:    District Auditor
• The Professional Executive Committee receives regular reports on all clinical aspects of assurance and provides an overview
of the organisation’s compliance with national and local standards                                                                  Address: Aspinall House
• The Risk Management Sub-Group monitors the performance of the internal control functions and reviews the Assurance                          Aspinall Close
Framework, prior to its endorsement of the Board                                                                                              Middlebrook

• The Audit Committee endorses and monitors the financial and corporate governance performance of the PCT                                     Bolton
                                                                                                                                              BL6 6QQ
• Internal Audit review the corporate governance performance of the PCT through the review of key Controls Assurance

• Executive Directors and Senior Managers have delegated responsibility for the achievement of organisational objectives and
risk minimisation, and for the management of risks generated within clinical and non-clinical areas

6. Conclusion

I am of the view that the mechanisms and systems outlined in this document demonstrate that the PCT has done its reasonable
best to maintain a sound system of internal control to manage the risks to achieving their objectives.

Stephen Mills                                  28th April 2006
Acting Chief Executive

                                                      Team Working                                                                                                               Having A Positive Approach
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